Rising tide could lift e-prescribing boat

WASHINGTON —Like rising floodwaters behind a weakening dam, a barrage of activity on Capitol Hill and elsewhere by pharmacy leaders, congressional lawmakers, technology vendors and other healthcare stakeholders could overwhelm the resistance of the nation’s physicians to paperless prescriptions and accelerate the shift to electronic prescribing.

Many forces suddenly are at work in the push for nationwide adoption of e-prescribing and health information technology. Among them: new proposals in Congress to lure or even force doctors into the new electronic era—and to eliminate federal restrictions on e-prescribing of controlled substances, a new advocacy campaign from the pharmacy benefit management industry, stepped-up lobbying efforts by pharmacy leaders and rising awareness of the benefits of paperless prescriptions among House and Senate lawmakers.

The final weeks of 2007 saw a slew of activity. On Dec. 18, 19 U.S. senators co-signed a letter to Attorney General Michael Mukasey in support of e-prescribing—urging an end to a Drug Enforcement Administration ban on the electronic transmission of prescriptions for controlled substances. “DEA regulations permitting [electronic prescription of controlled substances] have been delayed for years, inhibiting wider uptake of e-prescribing, and postponing the realization of this technology’s benefits,” the letter stated. “It is our belief that both the healthcare and law enforcement communities would benefit greatly from a secure EPCS system, and that technological solutions are at hand.”

That action came two weeks after a hearing before the Senate Judiciary Committee in which the National Association of Chain Drug Stores, Rite Aid vice president of pharmacy services Mike Podgurski and SureScripts chief executive Kevin Hutchinson asked Congress to help overturn the DEA restrictions.

“E-prescribing is safe and secure,” NACDS testified. It is an effective tool that is saving lives, improving the quality of health care and reducing the costs of care. The inability to e-prescribe controlled substances is preventing patients, prescribers and payers from taking advantage of these benefits.

“Moreover,” the group added, “the current federal roadblock is also depriving law enforcement of a tool that could help stop illicit prescribing and doctor-shopping and assist with diversion control.”

Podgurski told the Senate panel, Allowing controlled substance prescriptions to also be sent electronically is an important step in accelerating the rate of growth in e-prescribing in general.

“Currently, about 13 percent of all prescriptions written are for controlled substances. We believe that prescribers would be more willing to make the necessary technology infrastructure changes in their practices if all prescriptions, including controlled substance prescriptions, were able to be sent to pharmacists electronically,” he said.

Podgurski said Rite Aid has been involved for many years in the development of the current e-prescribing infrastructure—and that he was involved in the development of Rite Aid’s own e-prescribing system in 1998. “Our company has also been very actively involved in the development of the Pharmacy Health Information Exchange operated by Sure-Scripts,” he testified. “Rite Aid strongly supports the ability of prescribers to send and retail pharmacies to receive e-prescriptions for controlled substances.”

The chairman of the Senate Judiciary Committee, Sheldon Whitehouse, D-R.I., already has indicated his support for lifting the ban. “While e-prescribing could reduce adverse drug events, increase adherence to prescription regimens and save billions of dollars each year, federal regulations still require paper prescriptions for controlled substances often used to treat attention-deficit disorder, anxiety, pain and other ailments,” White-house said. “This requirement means that many doctors default to writing all prescriptions by hand rather than maintaining two systems.”

During his testimony, Hutchinson disclosed the results of the first National Progress Report on E-Prescribing. Published by SureScripts and based on data derived from the operations of the Pharmacy Health Information Exchange, the report features statistics measuring the current status of e-prescribing in the United States.

Among its findings:

There were more electronic prescriptions in the first three quarters of 2007 than in 2004, 2005 and 2006 combined, and the 2007 total will reach 35 million—or 2 percent of the estimated 1.47 billion new prescriptions and renewals eligible for electronic routing in the United States.

Of the 563,000 office-based physicians in the United States, 6 percent now are e-prescribing. SureScripts estimates the number of electronic prescribers will grow to approximately 85,000 next year.

More than 40,000 pharmacies now are accepting e-scripts, and that total should grow to 45,000 in 2008, according to the e-prescribing platform provider.

“There is a fully operational, nationwide infrastructure that closely adheres to all industry and government-approved standards for e-prescribing,” Hutchinson testified. He added, however, “Despite strong momentum and growth, this national asset is grossly underused. Every time a paper prescription is written, it is a lost opportunity to improve patient care.”

The push to convert physicians and federal lawmakers to an e-prescribing platform has drawn adversaries into a broad and unusual alliance—encompassing both retail pharmacy and the pharmacy benefit management industry. This is one campaign in which the Pharmacy Care Management Association—the nation’s chief PBM advocacy organization and a frequent critic of independent pharmacy—and the National Community Pharmacists Association find themselves on the same side.

PCMA, for its part, has stepped up its drive for e-prescribing with a new TV and print advertising campaign aimed at federal policymakers. To drive home its point, the PBM umbrella group has enlisted the support of well-known pharmacy advocate L. Lyle Bootman, dean of the College of Pharmacy at the University of Arizona.

Bootman is a vocal advocate of linking physicians and pharmacists through electronic data communications and health information technology, and last year co-chaired an Institute of Medicine committee that recommended that all physicians begin using e-prescribing by 2010 to help reduce the estimated 1.5 million preventable medication errors that occur in the United States annually. “However, fewer than 1-in-10 physicians currently use e-prescribing technology,” PCMA noted.

“Thousands of people die every year because of preventable medication errors,” Bootman said in the PCMA ad spot. “Many of them are America’s seniors.”

According to the IOM, about 7,000 people die from medication errors each year.

Along with the TV ad, PCMA also is running a print ad in Roll Call and other inside-the-Beltway publications with the headline: “While You Wait.” The print advertisement urges Congress to require e-prescribing in Medicare as a solution to the medication-error death rate.

S&P revises outlook on Rite Aid

NEW YORK Standard & Poor’s Ratings Services revised its outlook on chain drug retailer Rite Aid to negative from stable, the firm reported Friday. At the same time, S&P affirmed the ‘B’ corporate credit rating on Rite Aid.

“The outlook change reflects the company’s weak same-store sales and our expectation that this trend will continue over the next few quarters,” stated Standard & Poor’s credit analyst Diane Shand. Rite Aid faces a more cautious consumer, strong growth of lower-priced generics and intense competition, she said. In addition, the current environment could make it more challenging for the company to integrate its recently-acquired Brooks/Eckerd stores.

Boston Mayor decries in-store health clinics

BOSTON On the heels of the Massachusetts Public Health Council approving regulations allowing for in-store health clinics in the state, Boston Mayor Thomas Menino is reportedly looking to ban the clinics from opening in the city.

The decision by the health council “jeopardizes patient safety,” Menino said in a written statement, according to a Boston Globe report. “Limited service medical clinics run by merchants in for-profit corporations will seriously compromise quality of care and hygiene. Allowing retailers to make money off of sick people is wrong.”

The newspaper also reported that, in a separate letter, the mayor urged members of the city’s Public Health Commission to consider banning the clinics from opening within Boston. CVS has plans to open 20 to 30 MinuteClinics in the Greater Boston area but it is unclear how many of those would be within the city’s limits.

Defending its decision to allow clinics to operate, the state Public Health Council issued a statement that read: “The members of the Public Health Council were deliberative and thoughtful in their review of the limited service clinic regulation. We believe these types of clinics, operated either as part of a retail operation or in a nonprofit setting, can provide the public access to safe, convenient, and quality care for minor health issues.”

Officials at MinuteClinic were not immediately available for comment.

On Jan. 9, the state Public Health Council approved rules for limited service medical clinics. The new regulations took effect immediately.

“This is a new model for health care delivery that can benefit many people in the Commonwealth. These regulations will improve consumer convenience and make it easier for non-profit organizations to establish satellite clinics in a variety of settings to serve vulnerable populations,” stated secretary of Health and Human Services JudyAnn Bigby in a statement issued after the approval.

Added John Auerbach, commissioner of the Department of Public Health and chair of the PHC, “Properly regulated, these types of clinics will serve an important function, making care for minor medical care more convenient. The council was mindful of not wanting to create a stand-alone system of health care, so these regulations require coordination and linkages to primary care providers.”

The approval came at the end of a long review process that included two public hearings and the submission of hundreds of pages of testimony regarding the regulations, including testimony in favor of the clinics from the Convenient Care Association.

“We appreciate the Public Health Council’s careful deliberation regarding the adopted regulations that will now guide the operation of limited services clinics in Massachusetts. These retail-based clinics are providing consumers in 35 other states with easy access to high-quality, affordable health care in the face of a nationwide primary care physician shortage. Since this growing shortage is well documented in Massachusetts, and its related health care access issues have been exacerbated by the state’s near-universal healthcare coverage, we appreciate the Council embracing limited services clinics as a partial solution to these serious problems,” said Web Golinkin, president of the CCA and chief executive officer of in-store clinic operator RediClinic, in a statement issued after the council’s decision.

Sparking the move to create specialized regulations for these clinics was CVS’ application to open a MinuteClinic in one of its stores in Weymouth. According to the council, early in the application review process it became clear that DPH regulations governing medical clinics did not address the operation of medical clinics with limited scope of services. Rather than consider applications requiring numerous waivers from full-service clinic regulations, the department decided to create a specialized set of rules.

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